In the Rulebook on Waiting Lists, which was last amended in 2013, the Republic Health Insurance Fund (RFZO) prescribes the waiting periods for hip and knee implant surgeries. The prescribed periods may be up to six or up to twelve months long depending on the priority of the required procedures.
Zoran, Gordana, Branko and Mira, all from Obrenovac, have all spent time on waiting lists for hip or knee endoprosthesis surgery at the Banjica Institute in Belgrade. The quality of life during the waiting period deteriorated for each of them until it was almost unbearable due to severe pain and increasing limitations in doing everyday activities, from walking to sleeping. Some of them were told that their other hip would have to be replaced with an implant as a result of the overload it suffered.
Retired to pay for the hip replacement surgery with the retirement benefit
Mira (66) was employed when in 2021 she was put on the waiting list for hip endoprosthesis surgery at the Banjica Institute. Due to developed coxarthrosis (deteriorating cartilage in the hip joint), she had to have both her hips replaced.
“Both my hips were almost entirely worn out.”
Because of the agonizing pain she felt while waiting for the surgery, she describes her condition as something “she wouldn’t wish on her worst enemy”. She goes on and says that she virtually lived on painkillers, “one diclofenac pill in the morning before going to work, and a few more during the day” and that she became highly irritable.
“In such pain you’re not functional. (…) I became envious of people who could walk normally”, Mira explains.
Her daily walk to work, only some 200 yards from the apartment building without a lift that she lives in (on the third floor) became so painful that she had to be chauffeured to and from work by her husband.
She retired as soon as she met the retirement criteria and used the retirement benefit along with additional funds to pay (EUR 6,000) for one hip surgery at a private clinic. She was operated on a month after retirement, in December 2022.
“I knew that it wouldn’t be my turn at the Banjica Institute any time soon, so I decided to have at least one hip replaced and keep on waiting for the other hip surgery”, says Mira.
While waiting, she was offered a surgery in Kraljevo by RFZO, which she refused. The surgery took place at the Banjica Institute in September 2023, nine months after the first surgery at a private clinic and nearly two years after her entry onto the waiting list. She adds that among patients at the Banjica Institute there were women from Leskovac and Prijepolje.
“There was a woman from Leskovac, and another one from Prijepolje, this was, shall I say, extreme (…) and there I was, supposed to go to Kraljevo to be operated on. When you’ve undergone a surgery and you’re released from hospital, you’re not comfortable in a car during a ride from Belgrade to Obrenovac, not to mention a four-hour ride from Kraljevo. Why should I do that when I live in Obrenovac, why should I go for a surgical procedure that far?”, Mira wonders.
She believes that her first hip replacement surgery would not have taken place until 2024 had she not turned to the private health care. She says she feels “reborn” and has not regretted it.
Paid for physical therapy sessions to hold on until the surgery
Zoran (70) was put on the waiting list for his left hip endoprosthesis surgery on 8 March 2022. The expected surgical procedure date was in March 2025. Some years before that, he had begun to feel pain and thought the problem was his knee. In June 2021, during the first examination, he was diagnosed with left hip coxarthrosis and told that he needed hip replacement.
Perplexed at the diagnosis, when asked whether he wanted to be entered onto the waiting list, he replied that he would like to give it some thought and come again.
“That is how I wasted between six and nine months”, says Zoran.
He took diclopram painkillers, but the pain intensified as the time went by. He was unable to sit without leaning his back against something, had to sleep predominantly on his back and have a cushion between his legs to ease the pain during night. At one point he could no longer tie his shoelaces on his own or walk without a stick. His knee began to hurt, too.
Zoran was offered a surgery in the hospital in Vranje sooner than its expected date in Belgrade, which he refused because of the distance. In order to relieve pain and movement difficulty, he commenced physical therapy at a private institution at his own expense. He paid RSD 40,000 for the first ten treatments, after which he continued with the therapy sessions once a month. For three years in a row, he went to the Gornja Trepča Spa, using pensioner vouchers. At the end of last year, he received a call and instructions for pre-op preparation from the Banjica Institute.
He had a surgery on 30 January this year, almost three years after he was entered onto the waiting list. He was told that the other hip would also need replacing. He still does not know whether he will have to have a knee surgery as well.
A knee surgery in ten years?
Gordana (68) went to the Banjica Institute in February 2023, several years after she had first felt right knee ache, when the pain intensified and made her walking difficult.
“It was then that the doctor found that my right knee had totally worn out. He said that I was disabled, that I had to resign myself to using crutches when walking and have physical therapy”, Gordana tells us. The doctor warned her that the other knee will soon deteriorate, as well as the right hip, and put her on the waiting list since the surgery was the only solution for her. He then explained about the waiting period and that he was unable to help her wait less as great many people came with similar problems. He recommended using painkillers when in severe pain, Gordana remembers.
At first, she says, she should have waited for the surgery for ten years! Toward the end of last year, things started to change, and the expected date of her surgery was shifted to February 2026. Last year, RFZO offered her a surgery in Zaječar instead of the Banjica Institute, but she refused.
“I received a letter from RFZO, which said that it was in my best interest to have the surgery as soon as possible, that the Banjica Institute was overcrowded and there was nothing they could do about it. The Fund offered to pay for my prosthesis and to put me in hospital in Zaječar, where there were vacancies. I refused, and my family agreed, because being from Obrenovac, I had no intention of going all the way to Zaječar. (…) it seemed too far away and weird. I was born here, and having been living all my life here, being insured here in the Belgrade City territory, I shouldn’t go to Zaječar for a treatment”, Gordana explains.
She was unable to go to physical therapy sessions in Obrenovac Healthcare Centre because she could not walk there on her own and had nobody to give her a lift. She used crutches to walk and could not hold her right leg straight – her knee was always slightly bent.
Gordana took diclofenac pills against pain. Without her crutches, as she tells us, she could not reach the bathroom. Her right ankle was aching and swollen, and her left knee and hip started to hurt as well “because she was not walking properly”. She described the pain she felt when standing up after being seated for a while as “a disaster”.
After two years of waiting, she received an invitation from the Banjica Institute for a pre-op examination scheduled in early March. She had the surgery on 30 May, two years and four months following her entry onto the waiting list. She still does not know whether she will have the other knee operated on or not.
“Had I checked in immediately, my turn would have come long ago”
Branko (77) was entered onto the waiting list for his left hip endoprosthesis surgery in April 2024 and was told that the expected procedure date should be in April 2027. Five years prior, he had felt pain for the first time. He takes no painkillers ever, so he turned to alternative medicine. However, he soon realised it was not helping. He finally heeded the advice of a friend, who is a physician, and scheduled an examination, where he was told he needed replacement surgery on both hips.
“Anything I took seemed to relieve pain a little, some things didn’t work, but there was no true improvement.“
My friends who are medical doctors said that I shouldn’t get my hopes up too high.
“Once cartilage gets worn out, there is no way to restore it. There are gels that can be injected, you feel better for a few months, and then the treatment needs to be repeated. The best solution is a replacement surgery. So, there I was, didn’t enter the waiting list immediately. Had I done so, my turn would have come long ago, I would’ve gone through all that and recovered so far”, says Branko.
The pain he felt when walking intensified due to the hip cartilage wear and bone-on-bone friction. He hoped he would go up on the waiting list as more and more procedures were performed, but it did not happen. He thought of entering the waiting list for the University Clinical Centre of Serbia. Instead, he agreed to the treatment proposed by RFZO in the General Hospital in Vršac, where he had hip endoprosthesis surgery on 7 May. Following stitch removal and rehabilitation, he was released on 22 May and given a lift back to Obrenovac in an ambulance vehicle of the Healthcare Centre Obrenovac.
Branko should have the other hip replaced until this year end, upon consulting his surgeon, after his stay in a rehab spa institution. He believes he’s well on the way to his problem resolution.
“The bottom line is I’m not in pain anymore. Still, I do walk with difficulty, but it’s to be expected. I believe it’ll be fine. (…) It’s important to listen to the doctors and do it on time”, says Branko.
Ignoring the first symptoms and pain is a major mistake
A physiotherapist at the Healthcare Centre Obrenovac Indira Ralević tells us that all patients in need of hip or knee endoprosthesis surgery generally make two massive mistakes. Firstly, when feeling hip or knee pain, they fail to have a medical checkup and have the hips or knees x-rayed. Most patients see their doctors only when in severe pain and with already worn-out cartilage and wait for the surgery in such a condition for a few years. In most cases, the other hip or knee usually suffers and deteriorates in such circumstances.
“What deteriorates first is the other hip (knee) since the mass centre and the body weight are transferred to the healthy hip, which then bears the load. In time, this healthy hip wears down. The body statics changes as well because the two legs are not used evenly”, explains physiotherapist Ralević.
Then, as she elaborates, lumbar spine, which is the closest to the hip, and knee problems start, too. In the foreseeable future, everything below the problem site, plus a segment above it, will deteriorate. In case of a knee problem, the ankle will also suffer along with the hip, bearing the body weight load.
Secondly, as Ralević points out, there is failure to have physical therapy during the surgery waiting period. Physical therapy helps preserve the hip/knee movement amplitude and does not eliminate pain.
“The issue here is restricted hip/knee movement, with reduced amplitude. (…) Principally, muscles are connected by means of tendons or ligaments to joints. Without exercise, tendons and ligaments get shortened as they lose elasticity. The movement range gets reduced”, says Ralević.
“All of that makes post-surgery recovery difficult. Without physical activity and hip/knee targeted exercises, the normal hip/knee movement amplitude is reduced up to the point when one cannot move a leg sideways for as little as two inches. When a hip is replaced, the movement amplitude becomes higher, but it is never restored to the level it could have reached had the patient exercised to maintain the pre-surgery amplitude”, Ralević emphasises.
According to the data published on the website of RFZO, as of 31 December 2024, there were 6,121 and 9,833 people altogether on waiting lists for respective hip and knee endoprosthesis surgery at hospitals in Belgrade (Banjica Institute, University Clinical Centre of Serbia, KBC Zvezdara, KBC Zemun, KBC Bežanijska Kosa and VMA).
Five months later, as of 31 May 2025, those numbers went down to 5,207 and 8,683 patients for hip and knee endoprosthesis surgeries, respectively.
At the Banjica Institute alone, as of 31 December 2024, there were 4,305 patients on the hip replacement surgery waiting list, while 6,848 patients were awaiting knee replacement surgery.
As of 31 May 2025, at the Banjica Institute, 3,717 and 6,002 people were waiting for hip and knee endoprosthesis surgeries, respectively.